Aerobic Exercise for Menopause

Aerobic exercise has emerged as a versatile, non-pharmacological intervention that can improve a range of health outcomes in menopausal and postmenopausal women. Recent studies have explored its role—alone or in combination with nutrition education or specialized dietary patterns—in enhancing quality of life, vascular function, cognitive performance, blood pressure regulation, estrogen metabolism, and energy balance.

Protocols Studied in Research

Aerobic Exercise and Nutrition Education for Enhancing Quality of Life and Reducing Early Menopausal Symptoms [1]

• Protocol: In a randomized controlled trial involving 108 women in east Azerbaijan Province, Iran, participants were allocated by block randomization into four groups: nutrition education, aerobic exercise, combined exercise plus nutrition education, and control. Menopausal symptoms and quality of life were measured using the Greene and MENQOL scales at baseline, 8 weeks, and 12 weeks.
• Outcome: At week 8, both the exercise and exercise plus nutrition groups showed significantly lower Greene scores (adjusted mean differences of –5.1 and –8.0, respectively) compared to controls. At week 12, all intervention groups demonstrated significantly improved scores—with the greatest benefit in the combined group (–22.1 on MENQOL).

Aerobic Exercise Training for Improving Arterial Compliance and Reducing ADMA in Postmenopausal Women [2]

• Protocol: Thirty postmenopausal women were randomized to a 12‑week aerobic exercise training program (65–80% of maximal heart rate, 40–60 minutes per day, 3–6 days per week) or a control group. Plasma asymmetric dimethylarginine (ADMA) levels and carotid arterial compliance were measured before and after the intervention.
• Outcome: The exercise group showed a significant increase in carotid arterial compliance (P < 0.01) and a significant decrease in plasma ADMA concentrations (P < 0.05). Moreover, the change in arterial compliance was inversely correlated with the change in ADMA (r = –0.367, P < 0.05).

Aerobic Exercise with MIND Diet for Enhancing Brain Longevity in Postmenopausal Women [3]

• Protocol: In a parallel randomized controlled trial, 68 obese postmenopausal women (ages 60–75, BMI 30–39.9 kg/m²) were randomized to an experimental group that performed moderate-intensity treadmill exercise three times per week for 12 weeks combined with adherence to the MIND diet, or to a control group following the MIND diet only. Serum sex hormones, cognitive function, and functional levels were assessed at baseline and after 12 weeks.
• Outcome: The experimental group showed highly significant improvements (p < 0.01) in sex hormone levels, cognitive functions, and functional performance compared to the control group (p < 0.05), suggesting that the combination of aerobic exercise with the MIND diet can beneficially affect brain cell longevity despite postmenopausal sex hormone deficiency.

Aerobic Exercise (Intervention) for Lowering Resting Blood Pressure in Postmenopausal Women [4]

• Protocol: In a 12‑week study of 10 postmenopausal Caucasian women with high-normal or stage I hypertension, participants underwent moderate-intensity aerobic exercise (walking) for 12 weeks. Resting blood pressure was measured in both sitting and standing positions before and after the intervention, along with assessments of aerobic capacity and exercise tolerance.
• Outcome: After 12 weeks, average resting systolic/diastolic blood pressure decreased significantly by approximately 10/7 mm Hg (sitting) and 12/5 mm Hg (standing) (P < 0.001), with all subjects showing a reduction of at least 3–5 mm Hg. These results demonstrate that regular aerobic exercise can produce clinically meaningful reductions in resting blood pressure.

Aerobic Exercise for Modulating Estrogen Metabolism in Premenopausal Women [5]

• Protocol: In a randomized controlled trial, 212 sedentary, healthy, eumenorrheic premenopausal women were assigned to 16 weeks of 30 minutes of moderate-to-vigorous aerobic exercise five days per week or to a usual-lifestyle control group. Urinary estrogens and nine estrogen metabolites were quantified at baseline and study end using LC-MS/MS, and key ratios (e.g., 2-OHE1/16α-OHE1) were calculated.
• Outcome: The exercise intervention significantly increased the 2-OHE1/16α-OHE1 ratio in the exercisers (P = 0.043) compared with the control group, suggesting that increased physical activity may favorably modify estrogen metabolism, a potential mechanism for lowering breast cancer risk.

Aerobic Exercise Training for Reducing Exercise Blood Pressure in Overweight and Obese Postmenopausal Women [6]

• Protocol: In a 6‑month randomized controlled trial, 404 overweight and obese postmenopausal women were assigned to one of four groups: 4, 8, or 12 kcal/kg/week exercise energy expenditure, or a nonexercise control group. Exercise blood pressure was measured during the 50‑watt stage of a cycle ergometer maximal exercise test.
• Outcome: Significant reductions in exercise systolic blood pressure were observed in all exercise groups compared to control, with the highest dose (12 kcal/kg/week) also significantly reducing diastolic blood pressure (–13.7 and –4.3 mm Hg, respectively, P < 0.001 and P = 0.033). Resting blood pressure was unchanged, indicating that exercise-induced improvements are more evident during physical exertion.

Aerobic Exercise for Modulating Energy Compensation in Postmenopausal Women [7]

• Protocol: Data were combined from two multicenter randomized controlled trials (ALPHA and BETA) involving postmenopausal women aged 50–74 years, assigned to various exercise doses (150, 225, or 300 minutes per week) over 12 months. Energy compensation was calculated based on changes in body composition measured by DXA and estimated exercise energy expenditure, and associations with changes in VO₂peak and physical activity time were analyzed.
• Outcome: Although no significant differences in energy compensation were noted between different exercise doses, large inter-individual variability was observed; notably, increases in VO₂peak were significantly associated with lower energy compensation (β = –3.44 ml·kg⁻¹·min⁻¹, P = 0.0001), highlighting the importance of aerobic fitness in mitigating compensatory mechanisms that limit exercise-induced weight loss.

Research Interpretation: Summary and Conclusion

In simple terms, these protocols demonstrate that aerobic exercise can significantly improve both physical and metabolic health in menopausal populations. Combined interventions, such as exercise with nutrition education or the MIND diet, yield notable benefits in alleviating menopausal symptoms and enhancing brain longevity. Aerobic training improves arterial compliance and lowers markers of endothelial dysfunction, reduces exercise-induced blood pressure elevations, and favorably modulates estrogen metabolism in premenopausal women. Although individual energy compensation responses vary, higher aerobic fitness is linked to better weight management.

Overall, these findings support aerobic exercise as a safe and effective strategy for improving quality of life and reducing health risks associated with menopause.

Publications

[1] Asghari M, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Malakouti J, Nedjat S. Effect of aerobic exercise and nutrition educationon quality of life and early menopause symptoms:A randomized controlled trial. Women Health. 2017 Feb;57(2):173-188. doi: 10.1080/03630242.2016.1157128. Epub 2016 Feb 24. PMID: 26909662.

[2] Tanahashi K, Akazawa N, Miyaki A, Choi Y, Ra SG, Matsubara T, Kumagai H, Oikawa S, Maeda S. Aerobic exercise training decreases plasma asymmetric dimethylarginine concentrations with increase in arterial compliance in postmenopausal women. Am J Hypertens. 2014 Mar;27(3):415-21. doi: 10.1093/ajh/hpt217. Epub 2013 Nov 26. PMID: 24280041.

[3] Tanahashi K, Akazawa N, Miyaki A, Choi Y, Ra SG, Matsubara T, Kumagai H, Oikawa S, Maeda S. Aerobic exercise training decreases plasma asymmetric dimethylarginine concentrations with increase in arterial compliance in postmenopausal women. Am J Hypertens. 2014 Mar;27(3):415-21. doi: 10.1093/ajh/hpt217. Epub 2013 Nov 26. PMID: 24280041.

[4] Seals DR, Silverman HG, Reiling MJ, Davy KP. Effect of regular aerobic exercise on elevated blood pressure in postmenopausal women. Am J Cardiol. 1997 Jul 1;80(1):49-55. doi: 10.1016/s0002-9149(97)00282-8. PMID: 9205019.

[5] Smith AJ, Phipps WR, Thomas W, Schmitz KH, Kurzer MS. The effects of aerobic exercise on estrogen metabolism in healthy premenopausal women. Cancer Epidemiol Biomarkers Prev. 2013 May;22(5):756-64. doi: 10.1158/1055-9965.EPI-12-1325. PMID: 23652373; PMCID: PMC3648856.

[6] Swift DL, Earnest CP, Katzmarzyk PT, Rankinen T, Blair SN, Church TS. The effect of different doses of aerobic exercise training on exercise blood pressure in overweight and obese postmenopausal women. Menopause. 2012 May;19(5):503-9. doi: 10.1097/gme.0b013e318238ea66. PMID: 22547251; PMCID: PMC3341588.

[7] McNeil J, Brenner DR, Courneya KS, Friedenreich CM. Dose-response effects of aerobic exercise on energy compensation in postmenopausal women: combined results from two randomized controlled trials. Int J Obes (Lond). 2017 Aug;41(8):1196-1202. doi: 10.1038/ijo.2017.87. Epub 2017 Mar 31. PMID: 28360432; PMCID: PMC5550560.